The relation between physician experience and patterns of care for patients with AIDS-related Pneumocystis carinii pneumonia : Results from a survey of 1,500 physicians in the United States.
To determine whether physician experience and specialty influence the approach to care of AIDS patients with pneumonia, we surveyed physicians about their management of possible Pneumocystis carinii pneumonia (PCP) infection.
Design, setting, participants
A postal survey was sent to a random sample of 1,500 internists and family physicians in the United States drawn from the American Medical Association master file who were identified by a pharmaceutical marketing company as having written prescriptions for AIDS-related agents in the previous year.
Measurements and results
The survey had a 53% response rate.
Physicians more experienced in AIDS care were more likely to advocate diagnostic bronchoscopy over initiation of empiric anti-PCP therapy for HIV-infected patients with undiagnosed pulmonary infiltrates (odds ratio [OR], 1.4 for a patient with mild severity of illness [p=0.02] ; OR, 1.7 for a severely ill patient [p<0.001]). Physician specialty and fee-for-service reimbursement were independently associated with higher rates of bronchoscopy, with internists favoring bronchoscopy more frequently than family physicians.
High-experience providers and internists also predicted better clinical outcomes for the hypothetical patients.
Our findings extend the observations about HIV experience and PCP prophylaxis to the setting of diagnosis and treatment. (...)
Mots-clés Pascal : SIDA, Virose, Infection, Virus immunodéficience humaine, Lentivirus, Retroviridae, Virus, Homme, Pneumonie, Pneumocystis carinii, Fungi Imperfecti, Fungi, Thallophyta, Parasitose, Mycose, Complication, Médecin, Expérience professionnelle, Diagnostic, Prescription médicale, Exploration, Pronostic, Traitement, Immunopathologie, Immunodéficit, Appareil respiratoire pathologie, Poumon pathologie
Mots-clés Pascal anglais : AIDS, Viral disease, Infection, Human immunodeficiency virus, Lentivirus, Retroviridae, Virus, Human, Pneumonia, Pneumocystis carinii, Fungi Imperfecti, Fungi, Thallophyta, Parasitosis, Mycosis, Complication, Physician, Professional experience, Diagnosis, Medical prescription, Exploration, Prognosis, Treatment, Immunopathology, Immune deficiency, Respiratory disease, Lung disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0361751
Code Inist : 002B05C02D. Création : 14/12/1999.